Family Healthcare (FAMIS)

0905.025.16.10 Pre-Closing Review

IM-#193 December 28, 2000

If other eligibility cannot be established form the record, staff must take the process one step further by sending the Pre-Closing Review Notice (IM-80PRE) to inquire about pregnancy, blindness, disability, currency of child support payments, and changes in income.  The individual will be allowed ten (10) days to respond.  If there is no response from the individual indicating any other possible eligibility, an IM-80 (Adverse Action Notice) should be initiated explaining:

  • Reason for the loss of eligibility for the current program;
  • Reason ineligible for MC+ for MAF; and
  • Statement that we do not have any information that indicates eligibility for any other MC+ or medical assistance programs.

If the individual responds to the Pre-Closing Review Notice within the ten (10) days indicating other possible eligibility, register the appropriate (MA, MC+ for Pregnant Women, Non- Custodial Parent) application in IAPP and allow the current eligibility for that particular individual to remain open pending the eligibility determination for the other category.  No new signed application from the individual is required to switch categories.  If disability or blindness is claimed, use the IM-2D when determining eligibility under Medical Assistance.  If non- custodial parent eligibility is claimed, use the IM-1UA(NCP) when determining eligibility.  One category of coverage should not be stopped before the other category is approved or determined ineligible.

NOTE:  If the client did not respond to the expiration of the Pre-Closing Review Notice but does respond indicating other possible eligibility prior to the expiration of the IM-80, follow the same instructions above for the individual who responds to the Pre-Closing Review Notice.

If eligibility is established under another category, close the current active case and approve the other category the same date.  Use the IM-32 to notify the client of approval for MA with a statement that eligibility no longer exists under MC+.  Use the IM-33MCC to notify the client of the switch to MC+ for Pregnant Women with a statement that eligibility no longer exists for a specified program.  Use the IM-32NCP to notify the client of the switch to Non-Custodial Parent with a statement that eligibility no longer exists for a specified program.

If determined ineligible based on reported pregnancy, disability, blindness, change in income or child support payments, send an IM-80 specifying the reason eligibility for MC+/Medicaid does not exists.  Address the reason for the denial of the new category as well as the reason for loss of eligibility for current MC+ program.  The IM-80 will also serve as the rejection notice and provide appeal rights.  Close the MC+ active case once the IM-80 expires.

NOTE:  There are no appeal rights with the Pre-Closing Review Notice since this is not an adverse action notice.  If the final decision results in an adverse action, the IM-80 is required and normal hearing rights are allowed.